Inflammatory Bowel Disease

Overview

Inflammatory bowel disease, or IBD, is a general term that reflects an abnormal immune response resulting in inflammation of the intestinal tract. The two most common forms of IBD are ulcerative colitis and Crohn’s disease. Both diseases are believed to be caused by an abnormal response in the body’s immune system so that the digestive tract mistakes food and other materials as foreign substances. This stimulates a response to attack the cells of the intestines by sending white blood cells to the area to produce inflammation.

Ulcerative colitis

Ulcerative colitis is a chronic condition that affects the colon or large bowel only and is limited to the inner layer of the colon. The lining of the colon becomes inflamed and develops tiny, open sores (ulcers) that produce pus and mucus.

Symptoms of Ulcerative Colitis

One of the first symptoms of ulcerative colitis is loosening of the stool, which usually is bloody and may be accompanied by abdominal cramping and the severe urge to have a bowel movement (tenesmus). Other symptoms of ulcerative colitis include:

Decreased appetite

Weight loss

Fatigue

Anemia (from intestinal bleeding)

Skin lesions

Joint pain

Eye inflammation

Liver disorders

Malnutrition

Failure to thrive (in children)

Nausea

Fever

Ulcerative colitis may present some or all of these symptoms, and symptoms can be sporadic or consistent. In about half of all patients with ulcerative colitis, the disease is mild. Months or even years of remission may separate flare-ups. This makes it challenging for doctors to decide the best course of treatment. In the most severe cases of ulcerative colitis, patients may experience significant bleeding, severe abdominal pain and may require removal of the colon (colectomy).

Types of Ulcerative Colitis

There are four major types of ulcerative colitis:

Ulcerative proctitis—this is a milder type of ulcerative colitis, which has fewer complications and affects about 30 percent of patients with ulcerative colitis. Inflammation is isolated to the rectum.

Proctosigmoiditis—this colitis involves the rectum and the lower segment of the colon called the sigmoid colon.

Left-sided colitis—increasing in severity, this colitis involves continuous inflammation from the rectum to the bend in the colon under the stomach.

Pan-ulcerative colitis—this condition affects the entire colon. Generally speaking, this is the most severe form of colitis, which may ultimately require colectomy.

Treatment Options for Ulcerative Colitis

Medication- There are four classes of medication used to treat ulcerative colitis: mesalamines, steroids, immune modifiers and biologics. Approximately half of patients will have disease control with mesalamines. Ten to 15 percent of patients will eventually require surgery.

Surgery- When medications and diet are not successful, surgery is required to remove the colon. In many patients, surgeons can create an internal pouch from the small bowel and attach it to the anal sphincter muscle. This eliminates the need for the patient to wear an external ostomy appliance, where wastes are emptied into a pouch on the exterior of the abdomen. The advantage of removing the colon is that once the colon is eliminated, ulcerative colitis cannot recur again.

Crohn’s Disease

Named for Dr. Burrill Crohn who described the disease in 1932, Crohn’s disease produces chronic inflammation, which may involve any portion of the gastrointestinal tract. This disease affects at least 700,000 Americans. Most often, it affects the small bowel and the beginning of the colon, but it may affect any part of the digestive system from the mouth to the anus. There is also a wide range of severity in Crohn’s disease. It may affect all layers of the intestine, and frequently there may be healthy bowel tissue located between diseased tissues.

Symptoms of Crohn’s disease may include:

Persistent, diarrhea

Abdominal pain

Cramping

Rectal bleeding

Loss of appetite

Weight loss

Delayed growth and development in children

Fever

Fatigue

Crohn’s disease can also affect the eyes, skin, liver and joints. The most common complication from Crohn’s disease is intestinal blockage from swelling and scar tissue. Symptoms of a blocked intestine include pain, cramping, vomiting and bloating.

Serious Complications

Patients may experience tears called fissures in the lining of the anus, which cause bleeding and pain during bowel movements. Fistulas (a tunnel from one loop of intestine to another or to a different part of the body) may occur in many patients. In about one-third of Crohn’s patients, these fistulas become infected and require medical or surgical attention.

Treatment Options for Crohn's Disease

Medication- Medication is used to suppress the heightened immune responses that are causing inflammation. This suppression may relieve symptoms and allow the digestive system to heal. There are five groups of drugs that are used to treat Crohn’s disease: steroids, mesalamines, immune modifiers, antibiotics and biologic therapy.

Surgery- About 70 percent of Crohn’s patients require surgery at some point in their lives, usually when medications do not alleviate symptoms. Common surgical procedures include removal of fistulas, fissures, intestinal obstructions or diseased parts of the bowel. While surgery helps alleviate symptoms, it will not cure Crohn’s disease like surgery will cure ulcerative colitis.

Risk Factors for IBD

IBD affects men and women equally, but there are some distinct risk factors:

Age—IBD can occur at any age, but the most common age range for onset of symptoms is 15 to 30 years of age. About 10 percent of cases occur in individuals under 18 years of age.

Family history—having a first-degree relative with IBD increases your risk. Studies show that in Crohn’s disease, 5 to 20 percent of affected individuals had a first-degree relative with Crohn’s.

Ethnicity—Caucasians and those of Ashkenazi Jewish descent

Smoking—Crohn’s disease is more prevalent among smokers.

Where you live—Individuals who live in urbanized areas are more at risk than those living in rural areas. People in the northern hemisphere are more at risk than those in the southern hemisphere. The risk is higher in developed countries compared with undeveloped countries.

If you have symptoms of ulcerative colitis or Crohn’s disease, you should make an appointment with your doctor. Although these types of inflammatory bowel disease are similar, they have specific differences. Ulcerative colitis only affects the colon, whereas Crohn’s disease can affect any part of the GI tract. Also, ulcerative colitis affects only the lining of the colon, but Crohn’s disease can affect all layers of the bowel.

Inflammatory bowel disease (IBD) is very different from irritable bowel syndrome (IBS), which is a condition that causes muscle contractions of the colon and does not cause inflammation. IBD also increases the risk of colon cancer. Risk also depends on the type of IBD, how long the GI tract has been exposed to inflammation and how much of the colon is affected. Family history plays a very important role as well, so if you have immediate family with IBD, you should be especially diligent in your doctor visits and medical care.